Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? |
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Authors: | Marco Antonio Cardoso Machado Ligia Juliano Marcel Taga Luciane Bizari Coin de Carvalho Lucila Bizari Fernandes do Prado Gilmar Fernandes do Prado |
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Institution: | 1.Departments of Neurology and Internal Medicine,Federal University of S?o Paulo,S?o Paulo,Brazil |
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Abstract: | Mandibular repositioning appliances (tMRAs) designed with a titratable mechanism are effective to treat obstructive sleep
apnea syndrome (OSAS) but are not widely used, although many studies have proven their value. The aim of the present study
was to evaluate the efficacy of tMRAs in the treatment of OSAS on the criteria of the American Academy of Sleep Medicine (AASM;
apnea/hypopnea index AHI] < 5). Three hundred consecutive patients with a polysomnographic diagnosis of OSAS were referred
for treatment with tMRAs between 2000 and 2003. Thirty-eight patients were excluded, and 262 concluded the titration protocol
with tMRA that lasted 4 months. After titration, the patients were referred for a medical reassessment, and 83 patients (70
men) participated in the new polysomnographic exam with tMRA in place to access tMRA’s efficacy. The mean pre- and post-treatment
AHI were 26 ± 17.7 and 4.8 ± 5.3 events per hour, respectively (p < 0.00005). Fifty-three (62.6%) of the 83 patients were treated successfully (AHI < 5). Twenty-three patients had severe
OSAS, and 12 of them (52.1%) were treated successfully (AHI < 5). Forty patients had moderate OSAS, and 26 of them (65%) were
treated successfully. Twenty patients had mild OSAS, and 15 (75%) were successfully treated. Even when applying more rigid
criteria such as those of the AASM, the expressive success rate obtained with the treatment of different degrees of OSAS indicates
that tMRAs are an additional valuable option even for cases of severe apnea in which the patient does not tolerate continuous
positive airway pressure or cannot afford this treatment, a fact quite common in Brazil and other developing countries. |
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Keywords: | Sleep apnea OSAS Snoring Oral appliances Adults |
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